The efficacy of conbercept or ranibizumab intravitreal injection combined with laser therapy for Coats' disease

Abstract

Purpose: The current treatment approaches for Coats' disease by intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents (ranibizumab or conbercept) combined with laser therapy were evaluated for the efficacy during the treatment.

Methods: The medical records of 28 patients diagnosed with Coats' disease followed by the treatment with intravitreal injection of anti-VEGF agents and laser therapies at Tianjin Medical University Eye Hospital and Hebei Eye Hospital during July 2012 and October 2017 were reviewed retrospectively. Clinical outcomes were recorded with a minimum follow-up of 6 months. The patients were divided into ranibizumab- and conbercept-treated groups, as well as based on age: pediatric and adult groups.

Result: Twenty-eight patients were involved in this study. The average number of the injections was 2.82 ± 0.98. Laser photocoagulation was conducted in all patients, and the average number of lasers was 2.63 ± 0.74. The average follow-up period was 24.29 ± 9.85 months. Fourteen patients (50%) were stable, 12 (43%) patients were improved, and 2 patients (7%) showed recurred subretinal fluid and exudation. The final best corrected visual acuity (BCVA) increased markedly after intravitreal injection of ranibizumab or conbercept combined with laser therapy (p = 0.029, p = 0.009, respectively). The number of injections and lasers between conbercept and ranibizumab groups did not vary significantly (p = 0.160, p = 0.573, respectively). Nine patients (60%) in the ranibizumab-treated group and five (38%) in the conbercept-treated group reached a stable phase, and five (33%) and seven (54%) patients got the vision improved after treated with ranibizumab or conbercept, respectively. In pediatric and adult groups, the initial and final BCVA differed significantly (p = 0.03, p = 0.008, respectively). However, the injection number was remarkably different (p = 0.02), while the laser numbers did not have any markedly difference (p = 0.38).

Conclusion: Intravitreal injection of ranibizumab or conbercept combined with laser therapy is an effective therapeutic option in Coats' disease. Moreover, the intravitreal injection of ranibizumab or conbercept had no significant adverse effects and appeared to offer visual improvement in Coats' disease.

Keywords: Coats’ disease; Conbercept; Intravitreal injection; Laser photocoagulation; Ranibizumab.

Fig. 1

The fundus pictures of patient 1 from 2012 to 2017 (a–f). a The onset of Coats’ disease 2 months after initial one shot of laser and intravitreal injection. Telangiectasia and exudation in all quadrants of retina and exudative retinal detachment in posterior and peripheral retina. b One year after initial treatment. after three injections of ranibizumab and two times laser, the telangiectasia and exudative retinal detachment disappeared; exudation was limited around macular. c Eight months after b, Subretinal exudation was thinner and the macular exudation absorbed continuously. d One year after c, the subretinal and macular exudations were almost disappeared. e Thirteen months after d, the subretinal and macular exudations were completely absorbed. f One year after e, the macular had high-reflex scar at the end of follow-up. The lesion reached stable stage

Fig. 2

The OCT imaging of patient 1(a–f). a The macular exudation and edema at the onset 8 months after initial one laser and intravitreal injection. There was hemorrhage around the neovascularization. b One year after a, the macular exudation was limited in the center of macular. c Five months after b, the macular exudation absorbed slowly. d Six months after c, the macular exudation was absorbed continuously. e Seven months after d. f One year after d, macular exudation was completely disappeared and the subfoveal scar was confirmed